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Management of Scabies

1.  Consider as a possible diagnosis in anyone who is itchy. 

2.  Confirm diagnosis by identifying the burrows, which are linear scaly tracks ~ 1cm in length -

  • almost always found on hands, especially web space, side of finger, palm
  •   look at soles of feet in infants
  • lumps on male genitalia and female areola can be helpful confirmatory signs

3.  Be confident and upbeat with the patient -

  • can affect anyone (even Dermatologists) and is curable if instructions followed
  • give scabies information leaflet explaining nature of condition and its treatment   

4.  Treat patient with Permethrin 5% cream on two occasions, 7 days apart -

  • overnight application best (8 hours)
  • cover all skin from head to feet, except hair-bearing scalp, eyelids and mouth
  • make sure sufficient is prescribed --  
    - average adult 30g
    - large adult    60g
    - age 12 and over   30g
    - 5–12 15g
    - 2–5   7.5g
  • children under 2 years of age should be treated under medical supervision
  • use aqueous malathion (24 hours x 2 applications) if allergic to lanolin

5.  Treat all household members and other close contacts simultaneously, whether they have symptoms or not. Scabies is highly infectious and contacts may be asymptomatic as the incubation period is 2 – 6 weeks. Encourage the family not to delay treatment. It is important that all contacts apply treatment on the same day to minimize the chances of reinfestation from an untreated contact.

6. Tell patient itch  may persist for up to a month after treatment -

  • treat symptomatically with Crotamiton 10% (Eurax® ) cream, moderate-strength topical steroid, emollient or oral antihistamine

Refer to NHS Tayside’s Guidelines for the Control of Scabies infection when available (due to be published shortly) and PRODIGY Guidance - scabies for further advice.

Adverse Reactions to Topical Therapy
Use of Emollients
Management of Pruritus
Use of Topical Corticosteroids
Management of Eczema/Dermatitis
Management of Psoriasis
Management of Acne
Management of Warts
Dermatology Patient Pathways

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